Equivalent outcomes in patients with chronic myelogenous leukemia after early transplantation of phenotypically matched bone marrow from related or unrelated donors

PURPOSE: To determine if the favorable outcomes after transplantation of ma tched sibling donor bone marrow in patients with chronic myelogenous leukem ia can be achieved using bone marrow from an HLA-A,B/DRB1-matched unrelated donor. SUBJECTS AND METHODS: Between April 1983 and December 1997, 141 patients wi th chronic myelogenous leukemia in its first chronic phase received a bone marrow transplant from a matched sibling donor(n = 96) or an HLA-A,B/DRB1-m atched unrelated donor(n = 45). The median age of matched sibling donor rec ipients was 38 years (range, 8 to 56 years) and of unrelated donor recipien ts was 35 years (range, 3 to 53 years; P = 0.03). The median follow-up was 6 years (range, 1 to 15 years) in matched sibling donor recipients and 5 ye ars (range, 2 to 10 years) in unrelated donor recipients. RESULTS: There was no significant difference in the 5-year survival rates o f matched sibling donor recipients [58%; 95% confidence interval ICI), 48% to 68%] and unrelated donor recipients (53%; 95% CI, 39% to 67%; P = 0.4). Among patients who underwent transplantation within 1 year after diagnosis, the 5-year survival rate of matched sibling donor recipients (76%; 95% CI, 65% to 87%) was not significantly different (P = 0.5) from that of unrelat ed donor recipients (70%; 95% CI, 52% to 88%). In multiple regression analy sis, longer time from diagnosis to transplantation, T-cell depletion, and g rades III or IV graft versus host disease were independently associated wit h poorer survival. Transplantation of unrelated donor bone marrow was not a ssociated with mortality (relative risk, 1.1; 95% CI, 0.6 to 2.1; P = 0.7). CONCLUSIONS: Transplantation of bone marrow from a matched sibling donor or an HLA-A,B/DRB1-matched unrelated donor produces equivalent outcomes in pa tients with chronic myelogenous leukemia, particularly if the transplant ta kes place within 1 year after diagnosis. (C) 2001 by Excerpta Medica, Inc.